Date: February 14, 2020
To: Enrolled Hospice Agencies
Re: Nursing Facility Rate Changes Affecting Hospice Patient Room and Board Payment
This notice informs hospices of nursing facility rate changes that impact payment for hospice patient nursing home room and board.
Nursing facility rates were revised effective for dates of service beginning July 1, 2019. However, the Department was awaiting approval from the federal Centers for Medicare and Medicaid Services (CMS) to begin fee-for-service reimbursement at the revised rates. Payment continued at the nursing facility rates in effect as of June 30, 2019.
The Department sent email notification to nursing facilities and hospices in August 2019 and again in January 2020 instructing hospices to void and rebill claims when the rates were updated in order to be paid at the new rates. The Department recently received approval from CMS for the nursing facility reimbursement changes and has entered updated rates for the July 1, 2019 and October 1, 2019 quarters into the reimbursement system.
The Department will process adjustments for hospice providers for the difference on each claim. Hospice providers do not have to void and then rebill these claims. The Department anticipates the adjustments will be processed promptly. These adjustments will be identified on the remittance advice by Process Type 22C or 22D, Reason Code 3569 with the message “Hospice Adj for LTC Rate Changes.”
Questions regarding this notice may be directed to the Bureau of Hospital and Provider Services at 877-782-5565.